Kirby's EOH in NYT article

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http://www.nytimes.com/2005/04/17/books/review/17MORRICE.html?

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April 17, 2005

'Evidence of Harm': What Caused the Autism Epidemic?

By POLLY MORRICE

EVIDENCE OF HARM

Mercury in Vaccines and the Autism Epidemic: A Medical Controversy.

By Kirby.

460 pp. St. 's Press. $26.95.

ack in November 2002, when the journalist Kirby started

researching ''Evidence of Harm,'' he couldn't have known how good

his timing would be. His book on the contentious issue of whether

mercury in vaccines led to an autism epidemic is appearing in the

midst of what must be called an autism boom. In the past few months,

this unexplained brain disorder -- which skews language and social

skills, and can unloose fierce obsessions -- has hit a media

trifecta. Television news segments, a magazine cover story and a

host of newspaper articles have discussed its symptoms, treatments,

effects on families and, most controversially, its apparently

soaring incidence.

Why so much autism now? In part, the deluge is cyclical, as

journalists discover -- apologies to Yeats -- the fascination of

what's difficult. Yet this year's coverage has had a particular note

of urgency. Beginning in the late 1980's, the number of autism cases

started to take off. The latest estimates are that one child in 166

has some form of the disorder, with effects that range from mild to

crippling. These figures have raised vital questions. Is the

increase in autism real or the result of revised diagnostic criteria

and improved awareness? If the syndrome has become epidemic, is some

environmental factor partly to blame?

Kirby, who has contributed to various sections of The New York

Times, personalizes this dispute by introducing us to a collection

of parents who began to suspect that genetic tendencies might not

have induced their children's autism. Brought together by the

Internet, this group soon focused on thimerosal, a mercury-based

preservative once used in vaccines, including many that were added

to the immunization schedule in the early 1990's. When infants

received higher doses of thimerosal, it was suggested, the result

was an autism epidemic.

Many of Kirby's subjects have had sour encounters with the medical

establishment. One such couple, Lyn and Tommy Redwood, struggled to

obtain a diagnosis for their son Will, who at 17 months started to

lose his language and withdraw socially. When Will turned 4, his

latest ''expert'' doctor ran out of options: ''Why don't you just

take him fishing?'' Like the Redwoods, the other parents in Kirby's

book watched their children develop normally until the second year

of life. After receiving measles-mumps-rubella (M.M.R.) vaccines,

they regressed, developing symptoms of autism and severe

gastrointestinal problems.

Initially, the parents wrote off the rumors of a thimerosal-autism

connection, even though the idea that vaccines contributed to the

disorder wasn't new. In the mid-1980's, an antivaccine activist

collaborated on a book linking autism to the diphtheria-tetanus-

pertussis shot. And the British doctor Wakefield argued that

autism was an immune-system disorder brought on by live measles

virus in the M.M.R. vaccine (which does not contain thimerosal).

Then, in July 1999, the United States Public Health Service and the

American Academy of Pediatrics issued a statement calling for

vaccines containing thimerosal to be phased out as soon as possible.

The document noted that while babies had received cumulative doses

of ethylmercury (in thimerosal) that exceeded a federal safety limit

for methylmercury, its more toxic chemical cousin, there was

no ''evidence of harm.''

After reading the statement, Lyn Redwood toted up the micrograms of

mercury Will had received during his first six months and realized

that the government had averaged the mercury exposure on a per-day

basis rather than acknowledging that infants got potentially more

toxic ''bolus'' doses -- large amounts at one time. Meanwhile, other

parents, who would join with Redwood to form the Coalition for Safe

Minds, researched the similarities between mercury poisoning and

autism. They found a striking parallel in acrodynia, a 1930's

ailment that occurred in some children exposed to mercury in lotions

and teething powders.

From here on, Kirby follows the tug of war between government health

agencies and the parents and their supporters. At a succession of

hearings, the so-called Mercury Moms presented their research on

acrodynia and thimerosal, and a neurologist described his research

showing that tiny amounts of thimerosal triggered brain-cell death.

The federal agencies, in turn, cited seemingly conclusive

epidemiological studies. (Denmark, for example, removed thimerosal

from vaccines in 1992 but saw a rise in autism cases rather than the

expected drop.) The Safe Minds parents went home and picked the

studies apart. Despite their efforts, in May 2004 a committee from

the Institute of Medicine found no ''causal relationship'' between

thimerosal-containing vaccines, or the M.M.R. vaccine, and autism.

If this story has a smoking gun, it's the Vaccine Safety Datalink

thimerosal study. Based on data collected from H.M.O.'s, this

project, financed by the Centers for Disease Control, sought to

determine whether there was a correlation between the timing and

amounts of thimerosal infants received in vaccines and the emergence

of neurodevelopmental disorders, including speech delay, attention-

deficit disorder and autism. The Safe Minds statisticians contended

that the government analyses of such data were flawed in a way that

obscured or eliminated the original findings of statistically

significant risks.

''Evidence of Harm'' is filled with abbreviations and statistics,

but Kirby does an admirable job of clarifying most of the scientific

background -- including an explanation of the complex biochemical

process of methylation, which plays a central role in Safe Minds'

arguments. (The idea, in its simplest terms, is that in susceptible

people thimerosal blocks the ability of cells to regulate their

functions; these individuals cannot shed mercury -- or other toxins

or heavy metals -- from their bodies.) However, Kirby is less clear

on the nature of autism, which he sums up as ''a hellish, lost

world.'' In his account of one government hearing, an angry activist

denounces ''the traditional brain-and-genetics stuff'' of mainstream

research, but readers who aren't familiar with that ''stuff'' might

welcome a summary. Some researchers also suspect that thimerosal and

the M.M.R. vaccine delivered a one-two punch to the immune system --

the first weakened it, the second finished it off. A fuller

explanation of this theory would also have been helpful.

KIRBY doesn't offer his own verdict on the debate, although he makes

the unassailable point that American health agencies lagged in

calculating the amount of mercury being injected into babies. He

quotes Rick Rollens, a founder of the MIND Institute at the

University of California, , who thinks answers to the

thimerosal-autism question may come from his home state, which has

the country's most reliable system of tracking new cases. The

decline in infants' exposure to thimerosal, Rollens estimates, began

in 2001; he predicts the effects ''should start showing up in our

system in 2005'' -- in other words, any day now.

As for Will Redwood, his parents have tried applied behavioral

analysis, vitamin B-12, folinic acid and chelation, the chemical

removal of metals like mercury from the body. In third grade Will

was admitted to a mainstream private school, and at the age of 10 he

was becoming interested in girls. If one certain conclusion can be

drawn from ''Evidence of Harm,'' it's that Will's parents made the

right decision about going fishing.

Polly Morrice has written for Redbook and Salon. She is working on a

book about autism.

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